Information Collection

Traveler-based Genomic Surveillance Questionnaire

IC 259028 under ICR 202302-0920-019 · OMB 0920-1406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1406 can be found here:

Documents and Forms

Document Name Document Type
Traveler-based Genomic Surveillance Questionnaire Form
Information Collection Instrument Attachment 3 - Information Collection instrument.docx Form
Information Collection Instrument Attachment 3 - Information Collection instrument.docx Form
Attachment 4C - Potential additional questions.docx Potential Additional Questions IC Document
Attachment 4C - Potential additional questions.docx Potential Additional Questions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Traveler-based Genomic Surveillance Questionnaire	Agency IC Tracking Number:	0920-22ET

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Information Collection Instrument	Attachment 3 - Information Collection instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 555,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	555,000	555,000
Annual IC Time Burden (Hours)	46,250	46,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Potential Additional Questions	Attachment 4C - Potential additional questions.docx	03/09/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.